Nancy Eckerson: Compulsive exercise and eating disorders with runners

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Posted Aug. 5, 2012 at 3:15 AM

Posted Aug. 5, 2012 at 3:15 AM

I think it is fair to say that the running community in general is one that embraces the hard work of training; runners don't generally shy away from adding mileage and intensity to meet the goals of longer races and faster times. It is not unusual for training plans to include five or more days of running plus additional strength work, adding up to many hours of exercise in a week, all considered to be 'normal' for high school, college and recreational runners. But while this hard work ethic is accepted and relished by many runners, it can hide the struggles faced by some runners who are compulsive exercisers, and can also be characteristic of individuals with eating disorders. According to the National Eating Disorders Association, up to 11 million people in the U.S. have an eating disorder such as anorexia and bulimia, typically young women between the ages of 12 and 25, although it is likely underreported among men and older women. To better understand the topic, I spoke with local Nutrition Counselor Maria Larkin, M. Ed., RD, LD who counsels individuals with eating disorders and compulsive exercisers.

Given that many runners spend many hours exercising, what is the difference between a hard training schedule and compulsive exercise? Larkin referred to the American Psychiatric Association's criteria that does not describe excessive exercise in terms of duration or intensity but instead offers behavioral characteristics that can indicate the condition. These behaviors include when exercise significantly interferes with important activities, when it is done at inappropriate times and settings, when postponement of exercise creates feelings of intense guilt and failure, and when it cannot be controlled. Larkin said that exercise can be used as a way to purge calories, so another warning sign is when a person exercises solely to influence their weight and shape. Sports that showcase the body and equate being thin with speed and elegance such as track, long-distance running, gymnastics, swimming, ice skating and dance are more likely to have individuals with these disorders, said Larkin.

Larkin discussed other signs that may indicate that exercise has become compulsive, including when an individual experiences exhaustion, a change in mood and low energy availability but continues to train. Also, when there is injury, illness and a decline in performance but the individual still continues to train can all be warning signs of compulsive exercise, said Larkin, and this can begin a dangerous spiral into eating disorders. Friends and peers of the affected individuals tend to notice these changes first, but parents and coaches should also look for these signs and behaviors, particularly if an individual is losing weight, said Larkin.

The long-term effects of eating disorders and compulsive exercise can be devastating. Anorexia nervosa, where individuals are at 85% or less of normal body weight have an extremely slow heart rate, weakening of the heart, low blood pressure, lowered resistance to infection, loss of muscle tissue and bone, and in severe cases, can result in death. A syndrome known as the female athlete triad consists of three conditions in varying levels of severity: energy deficiency or eating disorders, menstrual disturbances or loss, and bone loss (including stress fractures) or osteoporosis. This syndrome, when athletes are not eating enough calories to compensate for the amount expended during exercise, can be a red flag and may lead to the development of a serious eating disorder, said Larkin. With an extreme amount of exercise, the normal signals the body uses to indicate it needs energy, such as hunger pangs, cannot keep up with the demands and even individuals who eat according to hunger may still lose weight, said Larkin.

Our society puts a premium on fitness and some individuals feel an inordinate amount of pressure to continue excessive exercise, explained Larkin, and they feel inadequate if they stop. Dieting can also be a trigger that can begin a cycle of eating disorders, said Larkin who advocates a healthy, balanced eating plan with adequate calories to fuel exercise and our busy days. Exercise guidelines for general health suggest 30 minutes of activity a day, five days a week, which is less, or in some cases, much less, than required for athletics. For some individuals, increases in the amount of exercise can spiral out of control and become compulsive, said Larkin.

It is good to remember that runners come in all shapes and sizes, and to be aware of behavioral changes that might point to the beginning of a problem before it becomes a full eating disorder. The statistics are quite sobering: according to the Eating Disorder Foundation, half of all individuals with an eating disorder have a full recovery, 30% have a partial recovery, and 20% have no substantial improvement in symptoms.

For individual nutritional guidance, you can reach Maria Larkin at mmlrd@aol.com, or 603-969-0017.

For more information on healthy eating for runners, see a related article featuring Larkin's nutritional advice for runners in this column, published Mar 4, 2012:http://fosters.com/apps/pbcs.dll/article?AID=/20120304/GJSPORTS_01/703049886/-1/FOSSPORTS1311.

Running Notes: Race season is busy all over the state; locally on Aug. 11, there is the Lamprey Health Care Annual 5K road race in Newmarket; on Aug. 12, for twice the fun, the Aqua Run2 takes place in Barrington at Mendum's Pond including a 1/3 mile swim and 1.5 mile trail run repeated twice.

Nancy Eckerson writes about running for Foster's Sunday Citizen. You can reach her at nerunner1@comcast.net.